Military Perspectives on the Provision of Spiritual Care in the Australian Defence Force: A Cross-Sectional Study.

A module to explore perspectives on chaplaincy services was included in an online enterprise survey randomly distributed to members of the Australian Defence Force (ADF) during 2021. Up to eight questions were answered by 2783 active military personnel relating to their perception of chaplain activities and the impact of chaplaincy services. Of those military participants answering the question on religious status (n = 1116), a total of 71.6% (n = 799) of respondents identified as non-religious while 28.4% (n = 317) identified as holding a religious affiliation. Approximately 44.2% (n = 1230) of participants had sought support from a chaplain, of which 85.3% (n = 1049) found chaplaincy care to be satisfactory or very satisfactory. While the data suggest there is a lack of clarity around the multiple roles undertaken by chaplaincy, nevertheless respondents were just as likely to prefer chaplains for personal support (24.0%), as they were to seek help from non-chaplaincy personnel such as a non-ADF counsellor (23.2%), their workplace supervisor (23.1%) or a psychologist (21.8%). This evidence affirms that the spiritual care provided by military chaplaincy remains one of several preferred choices and thus a valued part of the holistic care provided by the ADF to support the health and wellbeing of its members.

Spirituality, Mental Health, and COVID-19.

This issue of JORH presents a broad range of articles that consider spirituality and spiritual care from various international perspectives. It also looks at a diverse range of articles relating to mental health disorders and addictions. Lastly, this issue considers the aftermath of COVID-19. Readers are also reminded of the European Congress on Religion, Spirituality, and Health (ECRSH) (Salzburg, Austria), as well as the inaugural International Moral Injury and Wellbeing Conference (IMIWC), Brisbane, Australia, 2024.

The Effects of Contextual Factors on Hospital Chaplains: A Qualitative Study.

Critical questions arise about how contextual factors affect hospital chaplains. We interviewed 23 chaplains in-depth. Hospitals' religious or other institutional affiliation, geography, and leadership can influence chaplains both explicitly/directly and implicitly/indirectly-for example, in types/amounts of support chaplains receive, scope of chaplains' roles/activities, amounts/types of chaplains' interactions, chaplains' views of their roles and freedom to innovate, and patients', families' and other providers' perceptions/expectations regarding spiritual care. These data have critical implications for research, practice, and education.

"Powerful Strangers": A Reflection on Spirituality and the Chaplain-Doctor Partnership.

In this piece, Rachel Rim (Chaplain, MDiv) offers a poetic reflection on the nature of spirituality and the unique partnership between chaplains and doctors in the healthcare system, and particularly within the realm of palliative care.

Reflection on the Role of a Hospital Chaplain as a Resource for Ethical Concerns.

As I take a legal approach to religion and spirituality, I reflect on how a chaplain can be beneficial as a resource to ethical concerns with which medical teams and patients/caregivers are confronted. This rather new approach can help medical professionals to understand the scope of a chaplain's work and to distinguish the work of a chaplain from that of clergy in organized religion.

Pastoral Narrative Disclosure: The Development and Evaluation of an Australian Chaplaincy Intervention Strategy for Addressing Moral Injury.

This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in moral injury rehabilitation. Phase II: Development and Implementation of 'Moral Injury Skills Training' (MIST)-which involved the majority of available Australian Defence Force (ADF) Chaplains (n = 242/255: 94.9%) completing a basic 'Introduction to Moral Injury' (MIST-1) as well as an 'Introduction to PND' (MIST-2). Phase III: MIST-3-PND-Pilot evaluation-involved a representative chaplaincy cohort (n = 13) undergoing the PND eight-stage strategy to ensure the integrity and quality of PND from a chaplaincy perspective prior to wider implementation. The pilot PND evaluation indicated a favourable satisfaction rating (n = 11/13: 84.6%; M = 4.73/5.0 satisfaction). Phase IV: MIST-3-PND Implementation-involved a larger cohort of ADF Chaplaincy participants (n = 210) completing a revised and finalized PND strategy which was regarded favourably by the majority of ADF Chaplains (n = 201/210: 95.7%; M = 4.73/5.0 satisfaction). Phase V: Summation. In conclusion the positive satisfaction ratings by a significant number of ADF chaplaincy personnel completing MIST-3-PND, provided evidence that chaplains evaluated PND as a suitable counselling, guidance and education strategy, which affirmed its utilisation and justifies further research for using PND to address MI among veterans, that may also prove valuable for other chaplains working in community health and first responder contexts.

Towards a Holistic Model of Care for Moral Injury: An Australian and New Zealand Investigation into the Role of Police Chaplains in Supporting Police Members following exposure to Moral Transgression.

Police members can be exposed to morally transgressive events with potential for lasting psychosocial and spiritual harm. Through interviews with police members and police chaplains across Australia and New Zealand, this qualitative study explores the current role that police chaplains play in supporting members exposed to morally transgressive events. The availability of chaplains across police services and the close alignment between the support they offer, and the support sought by police, indicates they have an important role. However, a holistic approach should also consider organizational factors, the role of leaders, and access to evidence-based treatment in collaboration with mental health practitioners.

Reconfiguring the health-promoting hospital: the role of chaplaincy in England.

This paper seeks to explore how hospitals can be reconfigured to adopt more 'health-promoting' approaches and values. Specifically, the paper focuses on the role of hospital chaplaincy and argues that spiritual care should be considered alongside other health domains. Using semi-structured interviews, the aim of the paper is to explore the experiences of patients who accepted (n = 10) and declined (n = 10) hospital chaplaincy services. Data were analysed drawing on principles of interpretative phenomenological analysis (IPA). The findings suggested that participants who accessed chaplaincy services reported using the chaplains for pastoral, religious and spiritual care which contributed positively to their sense of well-being. This included religious rituals and supportive conversations. The majority of these participants had existing links with a faith institution. Participants who declined chaplaincy services reported having personal religious or spiritual beliefs. Other reasons cited, included: that the offer was made close to discharge; they had different support mechanisms; they were unaware of what the chaplaincy service offered. Participants identified a number of skills and attributes they associated with chaplains. They perceived them as being religious but available to all, somebody to talk to who was perceived as impartial with a shared knowledge and understanding. The paper concludes by highlighting the important role of chaplaincy as part of a holistic health-promoting hospital. This has implications not only for the design, delivery and promotion of chaplaincy services but also for health promotion more broadly to consider spiritual needs.

Improving access to palliative care clinical pastoral education.

Palliative care is interprofessional care for seriously ill people. Many clergy, religious leaders, and hospice and palliative care chaplains of color and minority religious backgrounds desire clinical palliative care education. This manuscript presents findings from a three-year quality improvement project which included the development of a palliative care specialty ACPE: The Standard for Spiritual Care and Education (ACPE) accredited program at an academic medical center. The program was designed to improve spiritual care provision in palliative care at the institution and to facilitate the participation of clergy and spiritual leaders of color and minority religious groups. Forty-six students participated in 53 400-h clinical pastoral education units. Strategies from medical education literature were employed to address obstacles to CPE participation including a racially and religiously diverse CPE advisory group, financial assistance, flexible learning (e.g. hybrid, asynchronous), and clinical placement agreements at places of employment. Upon completion of the program students provided written feedback, participated in a structured exit interview and completed a survey. Data were reviewed for common themes and results report student perceptions about the strategies utilized.

Chaplains of Color: Histories and Practices.

From the gallows and fields of war to the street and bedside, chaplains of color have been present and instrumental in providing spiritual and emotional support in public and private settings across the United States. Their histories and experiences are not well documented and integrated into the field of spiritual care and chaplaincy, a field often understood as predominantly White, male, and Christian. This article introduces this special issue by offering historical context-particularly for Black chaplains-and naming the key themes that weave through the articles included. Naming the experiences of chaplains of color is a central step in responding to historically grounded racial inequities in the work of chaplaincy and spiritual care in the United States.

Chaplaincy, Clergy, Prayer, Cancer and Measuring Religion and Health.

This third issue of JORH for 2023 revisits a number of themes previously highlighted in JORH, along with the addition of two new themes. Since JORH's first special issue on 'Chaplaincy' (JORH, 2022, 61:2), this area of research within JORH has now flourished, with a total of three JORH issues now incorporating the allied health discipline of chaplaincy. Two new article collections in this JORH issue relate to clergy 'faith leaders' and research related to 'prayer.' This issue also revisits the topic of cancer-a recurrent focus within JORH which has, over the past six decades, examined nearly every type of known cancer in the context of religion/spirituality. Finally, JORH collates once again, a number of articles relating to the empirical measurement of religion and health-an increasingly important area of research.

The Impact of Faith-Based Pastoral Care in Decreasingly Religious Contexts: The Australian Chaplaincy Advantage in Critical Environments.

This article considers the contribution of faith-based chaplains who provide holistic pastoral and spiritual care within critical environments such as the military, first responders, and hospitals. The contribution of faith-based chaplains can sometimes be taken for granted or not properly understood, particularly in some Western countries which are currently experiencing a decline in religiosity. Following on from a previous paper regarding chaplaincy utilization (Layson et al. 2022), this article presents an alternative argument to the secularist-humanist perspective by noting five ways by which the faith based chaplaincy model provides best practice service and builds a capability advantage for organizations that engage faith-based chaplaincy services. The first section discusses faith-based chaplaincy and organizational holistic care; the second section considers the role of faith-based chaplains-much of which is largely unknown and poorly appreciated; the third section considers the unique capability of faith-based chaplains to provide spiritual and religious care to those of faith and for those of none; the fourth section explores how faith-based chaplains can leverage the positive impact of religious organizations to provide additional low-cost resources for other organizations and their staff; and lastly, the operational advantage of faith-based chaplains on the world stage is considered, particularly in light of culturally and linguistically diverse populations to whom religiosity is increasingly important.

Spiritual Caregiving and Assessments for America's Religious 'Nones': A Chaplaincy Perspective.

One in four American patients now identify as religiously unaffiliated. This study utilizes thematic analysis to deliver qualitative results from in-depth interviews conducted with five chaplains at a premier cancer research institution in Florida to envision what care for their spiritual dimension should look like in practice. It demonstrates why the chaplains interviewed suggested that spiritual caregiving still contributes to their holistic wellbeing, and it suggests how spiritual care and assessments may be provided to so-called religious 'nones'-or those who identify as spiritual but not religious, not religiously affiliated, secular humanist, atheist, agnostic, and so on. We conclude with a novel spirituality assessment for use while serving this patient population.

Chaplaincy Perspectives on the Role of Spirituality in Australian Health and Aged Care.

The aim of this study was to explore Australian chaplains' views of spirituality. Semi-structured online interviews were conducted with 16 participants. Participants relied heavily on metaphors and analogies to describe spirituality. Four inter-related themes were identified through reflexive thematic analysis: (1) The core of spirituality: spirituality as a source of meaning or belief which leads to connectedness with something greater than oneself; (2) A function of spirituality: spirituality empowers people to cope in a crisis, by providing motivation, hope and comfort; (3) The experience of spiritual crisis: admission to hospital or residential care can lead to existential struggle; and (4) The spiritual practice: of holding space between struggle and growth. Greater understanding of the theoretical basis of their work may allow chaplains to offer more in the therapeutic space.

Patient Religiosity and Desire for Chaplain Services in an Outpatient Primary Care Clinic.

Outpatient chaplaincy is a new specialty in healthcare, with a relative paucity of research studies exploring the need for spiritual care interventions in ambulatory settings. Over the past 3 years, our interdisciplinary team at the Duke Outpatient Clinic has piloted the extension of professional spiritual care into this hospital-based resident teaching clinic offering primary care to underserved populations in Durham, NC. In this article, we report the results of a series of surveys that we conducted at the clinic to assess patients' perceptions of chaplain services, understanding of Chaplains' roles, and desire for chaplain services in specific hypothetical scenarios. As part of this survey, we also asked patients about their personal levels of extrinsic and intrinsic religiosity using the well-validated Duke University Religion Index. Our results indicate which chaplain interventions are most desired among this patient population in relation to patients' self-reported religiosity. We hypothesized that only our more religious patients would strongly desire chaplain support for the majority of scenarios presented. We were surprised to find that a majority of our patients-regardless of their own level of religiosity-express desire for support from an outpatient healthcare chaplain when they need a listening ear, are grieving a loss, or are seeking prayer.

Medical Students' Reflections on Their Experiences in a Trauma Chaplain Shadowing Program.

The importance of spirituality in patient care is well recognized and efforts to develop educational opportunities to improve medical students' competency in spirituality and health are ongoing. In this regard, shadowing of healthcare chaplains has emerged as an experiential approach for providing exposure to and instruction in issues of spirituality in the patient experience and in patient care. Recently published data suggest that a 6-8 hour experience of shadowing a trauma chaplain is effective at introducing first-year medical students to healthcare chaplaincy, difficult spiritual conversations with patients and families, and interprofessional collaboration. As a follow-up to these data, this study provides a qualitative analysis of student reflections written immediately after their shadowing experience with the goal of further characterizing the educational impact of trauma chaplain shadowing. Qualitative analysis of 90 anonymous, student reflections indicated that trauma chaplain shadowing was an experience that provided insights about nature of chaplaincy, enabled opportunities to closely observe the relational skills of chaplains, allowed students to bear witness to suffering, fostered growth toward a professional identity, and facilitated recognition of shortcomings in medical education and clinical medicine. These data therefore provide further evidence of the value of chaplain shadowing in not only enhancing students' understanding of various dimensions of spirituality and medicine but also in promoting their development of a strong physician identity.

Healthcare Chaplaincy and District Health Board Spiritual Care Policy in Aotearoa NZ: Review and Recommendations.

Healthcare in Aotearoa New Zealand is currently undergoing major reform. A document review of spiritual care policies of (former) District Health Boards (DHBs) obtained via the Official Information Act 1982 was undertaken in August 2022. Dalglish, Khalid and McMahon's (2020) READ process was used for analysis. Eight of twenty DHBs reported that they had no spiritual care policy. While there is commonality in terms of pastoral interventions provided, there is variation in how chaplains are expected to practice. Spiritual care policy needs to be refreshed and standardised to allow chaplains to better meet the diverse needs of patients receiving care in Aotearoa New Zealand hospitals.

Improving Professional Spiritual Care to Persons With Limited English Proficiency: The Cross-Language Chaplaincy Introduction Guidebook.

Hospitalized individuals in the United States with limited English proficiency (LEP) may experience complications when receiving hospital care. Grounded in the ethical principles of chaplaincy and motivated by the desire to address inequitable health service provision, we developed the Cross-Language Chaplaincy Introduction Guidebook. The Guidebook introduces chaplaincy in 20 different languages with the goal of improving chaplain accessibility. We report on the rigorous development of the Guidebook and how to integrate the resource clinically.

Chaplains' perspectives on standardizing spiritual assessments.

Chaplains are an integral part of mental health treatment within the Veterans Health Administration (VHA) and over the past decade, efforts have been made to integrate chaplain services into behavioral health treatment. One unique duty of chaplains is to conduct spiritual assessments, which are characterized as collaborative discussions with veterans to understand their overall religious and belief system, identify spiritual injuries, and how to integrate one's spiritual values into medical care. Although spiritual assessments in Veterans Affairs Medical Centers have evolved throughout the years to adopt a more structured approach, spiritual assessments can vary depending on site, clinical setting, and medical center. The present study sought to examine chaplains' perspectives on standardizing spiritual assessments and incorporating empirically validated measures into the assessments. Thematic analysis was conducted on two focus groups of chaplains from a large VHA medical center. Overall, chaplains appeared interested in standardizing spiritual assessments, with an expressed desire to maintain their current conversational format. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introducing Nursing Students to Pastoral Care Providers Via Simulation.

ABSTRACT: During a mock code simulation scenario in a medical-surgical undergraduate nursing course, two priests as pastoral care providers were included as interprofessional team members. Perceptions of the inclusion of pastoral care in an end-of-life simulation were assessed as part of a mixed-method study that included a qualitative analysis of debriefing sessions. Students reported an increase in awareness of the role of pastoral care in healthcare and learned to consider the spiritual aspects of end-of-life care. Participation of priests in an end-of-life simulation enhanced students' learning of spirituality as an aspect of nursing care.